Diagnostic Tests for Intestinal Conditions
Intestinal Conditions Tests: Book Excerpts
Home Diagnostic Testing
These home medical tests may be relevant to Intestinal Conditions:
- Colon & Rectal Cancer: Home Testing
- Food Allergies & Intolerances: Home Testing:
- Digestive-Related Home Testing:
Intestinal Conditions Diagnosis: Book Excerpts
Diagnosis of Intestinal Conditions: medical news summaries:
The following medical news items
are relevant to diagnosis of Intestinal Conditions:
Diagnostic Tests for Intestinal Conditions: Online Medical Books
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Review excerpts from medical books online, free, without registration,
for more information about the diagnostic tests for Intestinal Conditions.
CONSTIPATION:
DIAGNOSTIC WORKUP
(Algorithmic Diagnosis of Symptoms and Signs)
If the constipation is acute, a flat plate of the abdomen and a CBC would be in order to determine if the patient has intestinal obstruction. The workup of chronic constipation should include stool for occult blood, sigmoidoscopy, barium enema, or a colonoscopy. A chemistry panel and other diagnostic studies may be necessary to rule out systemic causes of constipation such as diabetes, hypothyroidism, and various conditions associated with hypercalcemia. If diagnostic tests yield no positive findings, referral to a psychiatrist or a gynecologist may be in order. A trial of a fiber diet may be helpful. At the same time, one should eliminate chronic laxative usage. Anorectal manometry will help diagnose rectal and anal sphincter dysfunction. Defecography will help diagnose anorectal dysfunction also. A neurologist should be consulted if urinary retention is also a problem.
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Source: Algorithmic Diagnosis of Symptoms and Signs, 2003
Constipation:
History and physical examination
(Handbook of Signs & Symptoms (Third Edition))
Ask the patient to describe the frequency of his bowel movements and the size and consistency of his stools. How long has he had constipation? Acute constipation usually has a physiological cause such as an anal or rectal disorder. In a patient older than age 45, a recent onset of constipation may be an early sign of colorectal cancer. Conversely, chronic constipation typically has a functional cause and may be related to stress.
Does the patient have pain related to constipation? If so, when did he first notice the pain, and where is it located? Cramping abdominal pain and distention suggest obstipation — extreme, persistent constipation due to intestinal tract obstruction. Ask the patient if defecation worsens or helps relieve the pain. Defecation usually worsens pain, but with such disorders as irritable bowel syndrome, it may relieve it.
Ask the patient to describe a typical day's diet; estimate his daily fiber and fluid intake. Ask him about changes in eating habits, medication or alcohol use, or physical activity. Has he experienced recent emotional distress? Has constipation affected his family life or social contacts? Also, ask about his job and exercise pattern. A sedentary or stressful job can contribute to constipation.
Find out whether the patient has a history of GI, rectoanal, neurologic, or metabolic disorders; abdominal surgery; or radiation therapy. Then ask about the medications he's taking, including opioids and over-the-counter preparations, such as laxatives, mineral oil, stool softeners, and enemas.
Inspect the abdomen for distention or scars from previous surgery. Then auscultate for bowel sounds, and characterize their motility. Percuss all four quadrants, and gently palpate for abdominal tenderness, a palpable mass, and hepatomegaly. Next, examine the patient's rectum. Spread his buttocks to expose the anus, and inspect for inflammation, lesions, scars, fissures, and external hemorrhoids. Use a disposable glove and lubricant to palpate the anal sphincter for laxity or stricture. Also, palpate for rectal masses and fecal impaction. Finally, obtain a stool sample and test it for occult blood.
As you assess the patient, remember that constipation can result from several life-threatening disorders, such as an acute intestinal obstruction and mesenteric artery ischemia, but it doesn't herald these conditions.
» READ BOOK EXCERPT ONLINE »
Source: Handbook of Signs & Symptoms (Third Edition), 2006
Constipation:
History and physical examination
(Professional Guide to Signs & Symptoms (Fifth Edition))
Ask the patient to describe the frequency of his bowel movements and the size and consistency of his stools. How long has he had constipation? Acute constipation usually has an organic cause, such as an anal or rectal disorder. In a patient over age 45, a recent onset of constipation may be an early sign of colorectal cancer. Conversely, chronic constipation typically has a functional cause and may be related to stress.
Does the patient have pain related to constipation? If so, when did he first notice the pain, and where is it located? Cramping abdominal pain and distention suggest obstipation—extreme, persistent constipation due to intestinal tract obstruction. Ask the patient if defecation worsens or helps relieve the pain. Defecation usually worsens the pain, but in disorders such as irritable bowel syndrome, it may relieve it.
Ask the patient to describe a typical day’s menu; estimate his daily fiber and fluid intake. Ask him, too, about any changes in eating habits, medication or alcohol use, or physical activity. Has he experienced recent emotional distress? Has constipation affected his family life or social contacts? Also, ask about his job. A sedentary or stressful job can contribute to constipation.
Find out whether the patient has a history of GI, rectoanal, neurologic, or metabolic disorders; abdominal surgery; or radiation therapy. Then ask about the medications he’s taking, including over-the-counter preparations, such as laxatives, mineral oil, stool softeners, and enemas.
Inspect the abdomen for distention or scars from previous surgery. Then auscultate for bowel sounds, and characterize their motility. Percuss all four quadrants, and gently palpate for abdominal tenderness, a palpable mass, and hepatomegaly. Next, examine the patient’s rectum. Spread his buttocks to expose the anus, and inspect for inflammation, lesions, scars, fissures, and external hemorrhoids. Use a disposable glove and lubricant to palpate the anal sphincter for laxity or stricture. Also palpate for rectal masses and fecal impaction. Finally, obtain a stool specimen and test it for occult blood.
As you assess the patient, remember that constipation can result from several life-threatening disorders, such as acute intestinal obstruction and mesenteric artery ischemia, but it doesn’t herald these conditions.
» READ BOOK EXCERPT ONLINE »
Source: Professional Guide to Signs & Symptoms (Fifth Edition), 2006
Constipation:
Physical examination
(The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter)
Undertake a general physical examination looking for the stigmata of the associated constitutional illnesses mentioned in the MADE-O-FUN acrostic. Target the abdominal examination specifically for masses or abdominal tenderness and the rectal examination for fecal occult blood, rectal tone, rectal masses, rectal foreign body, impaction, anal fissure, hemorrhoids, or rectocoele—essential parts of the evaluation.
Diagnostic testing
Laboratory evaluation should consist of fecal occult blood testing (FOBT) looking for rectal bleeding; serum potassium and calcium to rule out hypokalemia and hypercalcemia (both associated with decreased colonic tone); serum glucose to evaluate possible diabetes; complete blood count looking for anemia (possibly related to chronic GI blood loss from tumor); blood urea nitrogen, serum creatinine, or both to rule out renal failure; and thyroid stimulating hormone to evaluate for hypothyroidism.
Visualize the lower colon via flexible sigmoidoscopy in patients aged more than 40 years whose constipation is of recent origin. Flexible sigmoidoscopy alone is insufficient for patients whose findings could suggest colonic neoplasia (melena, positive FOBT, hematochezia, abdominal mass, unexplained weight loss, or unexplained anemia). These patients should be offered either (a) colonoscopy or (b) barium enema plus flexible sigmoidoscopy.
Diagnostic assessment
The key diagnostic task in adults presenting with constipation is identifying those occasional patients whose constipation is caused by colorectal cancer. Because survival from colon cancer is directly related to the stage of the disease at time of diagnosis (3), patients whose history, examination, or laboratory findings are more suggestive of this diagnosis merit prompt investigation, including referral if necessary.
For patients whose constipation can be related to a particular systemic disease (e.g., hypercalcemia or hypothyroidism) or the use of particular medications (e.g., clonidine or an aluminum-containing antacid), identifying that link can be instrumental in ensuring that inciting issues are appropriately addressed in the management of the patient as a whole entity and not just as “a colon.”
In that greater host of patients whose initial evaluation suggests a more benign cause of constipation, or for whom constipation seems to be an incidental feature in an otherwise well individual, the decision to proceed with colonic visualization, or to begin a search for more unusual causes (the “U” in the MADE-O-FUN acrostic) will depend on the degree to which the constipation subjectively has an impact on the patient’s ability to live a fulfilling, happy, and rewarding life.
References
1. Drossman DA, McKee DC, Sandler RS, et al. Bowel patterns among subjects not seeking health care. Use of a questionnaire to identify a population with bowel dysfunction. Gastroenterology 1982;83:529–534.
2. Sonnenberg A, Koch TR. Physician visits in the United States for constipation: 1958–1986. Dig Dis Sci 1989;34:606–611.
3. Steele G. Colorectal cancer. In: Murphy GP, Lawrence W, Lenhad RE, eds. American Cancer Society textbook of clinical oncology, 2nd ed. Atlanta: The American Cancer Society, 1995:Chap 14.
» READ BOOK EXCERPT ONLINE »
Source: The 10-Minute Diagnosis Manual: Symptoms and Signs in the Time-Limited Encounter, 2000
Constipation:
Diagnostic Approach
(Field Guide to Bedside Diagnosis)
Determine what the patient means by constipation. Patients are bothered by straining, excessively hard stools, unproductive urges, infrequency, and a feeling of incomplete evacuation.
With recent-onset constipation, seek an obstructing lesion, such as colon cancer, stricture, diverticular disease, inflammatory bowel disease, or foreign body. Hard stool in the vault rules out mechanical obstruction and suggests impaired emptying of the rectal vault. A change in stool caliber is more often caused by a tight sphincter than an “apple core” lesion.
» READ BOOK EXCERPT ONLINE »
Source: Field Guide to Bedside Diagnosis, 2007
Constipation:
Physical assessment
(Signs & Symptoms: A 2-in-1 Reference for Nurses)
Inspect the abdomen for distention or scars from previous surgery. Then auscultate for bowel sounds, and characterize their motility. Percuss all four quadrants, and gently palpate for abdominal tenderness, a palpable mass, and hepatomegaly. Next, examine the patient’s rectum. Spread his buttocks to expose the anus, and inspect for inflammation, lesions, scars, fissures, and external hemorrhoids. Use a disposable glove and lubricant to palpate the anal sphincter for laxity or stricture. Also, palpate for rectal masses and fecal impaction. Finally, obtain a stool specimen and test it for occult blood.
» READ BOOK EXCERPT ONLINE »
Source: Signs & Symptoms: A 2-in-1 Reference for Nurses, 2007
Constipation:
Diagnostic Approach
(The Diagnostic Approach to Symptoms and Signs in Pediatrics)
Diagnosisof many causes of constipation can be made by history and physicalexam.Age is a key factor. Although neonatesare more likely to have anatomic cause, most common causes in infantsand children are inadequate fluid and fiber in diet and combinationof developmental, situational, and psychologic factors.Physical exam is usually normal withmild constipation, whereas with severe constipation, stool is oftenpalpable in lower left quadrant and rectum is filled with hard feces.Abdominal radiograph shows presenceof stool, its extent, and whether lower spine is normal.If constipation fails to improve withusual therapy of adequate fluid intake, high-fiber diet, and laxatives,other disorders (e.g., congenital aganglionic megacolon) shouldbe suspected.
» READ BOOK EXCERPT ONLINE »
Source: The Diagnostic Approach to Symptoms and Signs in Pediatrics, 2006
Constipation:
History and physical examination
(Nursing: Interpreting Signs and Symptoms)
Ask the patient to describe the frequency of his bowel movements and the size and consistency of his stools. How long has he had constipation? Acute constipation usually has a physiological cause such as an anal or rectal disorder. In a patient older than age 45, a recent onset of constipation may be an early sign of colorectal cancer. Conversely, chronic constipation typically has a functional cause and may be related to stress.
Does the patient have pain related to constipation? If so, when did he first notice the pain, and where is it located? Cramping abdominal pain and distention suggest obstipation—extreme, persistent constipation due to intestinal tract obstruction. Ask the patient if defecation worsens or helps relieve the pain. Defecation usually worsens pain, but with such disorders as irritable bowel syndrome, it may relieve it.
Ask the patient to describe a typical day's diet; estimate his daily fiber and fluid intake. Ask him about recent changes in eating habits, medication or alcohol use, or physical activity. Has he experienced recent emotional distress? Has constipation affected his family life or social contacts? Also ask about his job and exercise pattern. A sedentary or stressful job can contribute to constipation.
Find out whether the patient has a history of GI, rectoanal, neurologic, or metabolic disorders; abdominal surgery; or radiation therapy. Then ask about the medications he's taking, including opioids and over-the-counter preparations, such as laxatives, mineral oil, stool softeners, and enemas.
Inspect the abdomen for distention or scars from previous surgery. Then auscultate for bowel sounds, and characterize their motility. Percuss all four quadrants, and gently palpate for abdominal tenderness, a palpable mass, and hepatomegaly. Next, examine the patient's rectum. Spread his buttocks to expose the anus, and inspect for inflammation, lesions, scars, fissures, and external hemorrhoids. Use a disposable glove and lubricant to palpate the anal sphincter for laxity or stricture. Also palpate for rectal masses and fecal impaction. Finally, obtain a stool sample and test it for occult blood.
As you assess the patient, remember that constipation can result from several life-threatening disorders, such as an acute intestinal obstruction and mesenteric artery ischemia, but it doesn't herald these conditions.
» READ BOOK EXCERPT ONLINE »
Source: Nursing: Interpreting Signs and Symptoms, 2007
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